Cumulative incidence and mortality of infective endocarditis in Siriraj hospital-Thailand: a 10-year retrospective study.

backgroundTo investigate the cumulative incidence of and factors associated with mortality among patients with infective endocarditis (IE) at Thailand's largest national tertiary referral center.

methodsMedical charts of adult patients diagnosed with IE by Duke criteria at Siriraj Hospital during January 2005 to May 2015 were retrospectively reviewed.

resultsOf 380 patients, 66.3% had definite IE, and 81.3% had native valve IE (NVE). Cumulative IE incidence was 5.67/1000 admissions. The most common pathogens were viridans group streptococci (VGS) (39.7%), methicillin-sensitive Staphylococcus aureus (MSSA) (13.1%), and beta-hemolytic streptococci (11.5%) in NVE; and, MSSA (20.3%), VGS (20.3%), and Enterococcus spp. (16.9%) in prosthetic valve (PVE) or device-related IE (DRIE). Overall in-hospital mortality was 18.4%. Mortality was significantly higher in PVE/DRIE than in NVE (26.8% vs. 16.5%, p = 0.047). End-stage renal disease (ESRD) (aOR: 9.43, 95% CI: 2.36-37.70), diabetes mellitus (DM) (aOR: 2.81, 95% CI: 1.06-7.49), neurological complication (aOR: 14.16, 95% CI: 5.11-39.22), congestive heart failure (aOR: 4.32, 95% CI: 1.91-9.75), hospital-acquired infection (aOR: 3.78, 95% CI: 1.66-8.57), renal complication (aOR: 3.12, 95%CI: 1.32-7.37), and other complication during admission (aOR: 3.28, 95% CI: 1.41-7.61) were independently associated with mortality.

conclusionsThe incidence of IE, and the mortality rate among those diagnosed with IE are both increasing in Thailand - particularly among those with PVE or DRIE. End-stage renal disease, diabetes mellitus, and development of IE-related complications during admission were found to be independent predictors of mortality.